EEG-based neurofeedback training with shoulder exoskeleton robot assistance triggered by the contralesional primary motor cortex activity in poststroke patients with severe chronic hemiplegia

K. Takasaki, F. Liu, M. Ogura, K. Okuyama, M. Kawakami, K. Mizuno, S. Kasuga, T. Noda, J. Morimoto, M. Liu, J. Ushiba

Research output: Contribution to journalArticle

Abstract

Introduction/Background: Recent clinical studies have shown that electroencephalogram- (EEG) based neurofeedback training promotes functional recovery of finger movements in poststroke patients (Pichiorri F et al., Ann Neurol. 2015). However, impairment of shoulder elevation in poststroke severe chronic hemiplegia is a debilitating condition with no evidence-based, accessible treatment. To verify motor recovery evidence of neurofeedback training with our shoulder exoskeleton robot, this study reports upper extremity section of Fugl-Meyer assessment (FMA-UE) associated with the evaluation of up-conditioning of contralesional corticospinal pathways. Material and method: Eight poststroke patients with severe hemiplegia in the chronic stage were recruited (FMA-UE score = 16.8 ± 4.4). Patients engaged in 1 hour daily training for 7 consecutive days (Fig. 1), and clinical and neurophysiological measurements were performed 1 day before and after the intervention. FMA-UE was used for the primary outcome measure. A 128-channel whole-head EEG was used to assess the hemispheric lateralization of event-related desynchronization (ERD). Single-pulse transcranial magnetic stimulation (TMS) was applied to the contralesional primary motor cortex to assess the corticospinal excitability in 6 tested patients. Results: All participants finished the intervention without adverse events. FMA-UE was significantly improved after the intervention (paired t-test, P < 0.01). All patients demonstrated improved FMA-UE (mean change = 6.6 ± 3.2) and 6 of 8 patients exceeded the minimal clinically important difference that is set to 5. From the group analysis of hemispheric lateralization of ERD, the contralesional ERD became stronger after interventions (Wilcoxon signed-rank test, P < 0.01). Motor evoked potentials became more apparent after interventions in 3 of the 6 tested patients. Conclusion: The results from this study demonstrated targeted up-conditioning of contralesional corticospinal pathways and efficacy of neurofeedback training with our shoulder exoskeleton robot.

Original languageEnglish
JournalAnnals of Physical and Rehabilitation Medicine
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Keywords

  • Brain machine interface
  • Neurorehabilitation
  • Phase 2 clinical study

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Rehabilitation

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